METHODS

Design:

Allocation:

Blinding:

blinded (data collectors).

Follow up period:

1 year.

Setting:

accident and emergency departments (EDs) in a university teaching hospital and an affiliated district general hospital in
the UK.

Patients:

313 patients >65 years of age (mean age 77 y, 72% women) who presented to an ED with a fall or fall related injury and had
⩾1 previous fall in the preceding year. Exclusion criteria included cognitive impairment (Mini Mental State Examination score
<24), >1 previous episode of syncope, immobility, and clear medical explanation for falling.

Outcomes:

number of falls, proportion of patients continuing to fall, and proportion of patients with fall related hospital admissions.
A “fall” was defined as inadvertently coming to rest on the ground or other lower level with or without loss of consciousness
or injury.

Patient follow up:

MAIN RESULTS

The multifactorial intervention group had a lower mean number of falls per year than the conventional care group (mean 3.3
v 5.1; relative risk 0.64, 95% CI 0.46 to 0.90). The 2 groups did not differ for proportion of patients continuing to fall
or proportion of patients with fall related hospital admissions (table).

Commentary

A high quality systematic review suggests that multifactorial interventions reduce the proportion of people who fall,1 whereas the study by Davison et al found only a reduction in the number of falls per year.

Several points might explain this finding. Firstly, the mean age of patients was 77 years. Similar studies have reported mean
ages >80 years.1,2 As well, the proportion of frail older adults was unknown. It is possible that the sample in the study by Davison et al included a lower proportion of frail older adults than previous studies. Secondly, 20% of the conventional care group visited
a falls clinic and received some of the same treatment as the intervention group, which may have masked any beneficial effect
of the intervention. Patients who received treatment from the falls clinic were likely those assessed as potentially benefiting
most from intervention. Thirdly, the multidisciplinary team did not include nurses, whereas many previous studies did.1

Nevertheless, the findings of Davison et al have implications for nurses. Despite its differences from previous studies, this research confirms the benefits of multifactorial
interventions in reducing the number of subsequent falls. It also reminds us that the assessment of people who fall is complex.
A fall may indicate presentation of a new illness or worsening of a chronic illness. With these points in mind, discharge
planning from the ED should include occupational therapy and physiotherapy assessments and assistance with personal care if
function has been lost because of injury.